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Obesity. Acne. Dandruff. Cold sores. These problems are common, visible — and embarrassing. But what is even more embarrassing?

The unexpected answer is sweat stains on clothing — at least according to a 2008 poll conducted by the International Hyperhidrosis Society (IHHS).

While not everyone might rank excessive sweating as the worst of that pack, many know from experience just how upsetting heavy perspiration can be. Nearly eight million Americans suffer from hyperhidrosis, a condition that causes excessive and persistent sweating in the underarms, hands, feet, or groin, according to the American Academy of Dermatology (ADD).

Of the two forms of hyperhidrosis — primary focal and secondary generalized — the first is the more common. A diagnosis of primary focal hyperhidrosis is made when excessive sweating, unrelated to other medical conditions, occurs at least once a week. The condition often starts in childhood or adolescence and most frequently affects the hands and feet. Though its cause is unclear, this type of hyperhidrosis does tend to run in families.

Secondary generalized hyperhidrosis, on the other hand, is linked to a separate health condition or medication regimen. For this reason, a doctor will first treat the underlying issue to see if that helps ease the perspiration problem before suggesting options for treating the hyperhidrosis directly.

Not surprisingly, both forms of hyperhidrosis can increase a person's risk of depression and/or anxiety due to embarrassment and physical discomfort.

Daily Life With Excessive Sweating

Hyperhidrosis can also directly affect everyday lifestyle choices, and people with the condition often learn tricks to minimize sweat stains on their clothes. They shun certain fabrics (such as satin or silk), for instance; they stay away from form-fitting clothing, dress in dark colors, and change frequently throughout the day. Some even alter their garments to defend against sweat stains.

"I had a client who had me sew a whole body armor for her," says Kara Saun, fashion designer and former contestant on the fashion-design reality TV show Project Runway. "This condition is definitely something that people take me aside to say, 'I've got to let you know about this because you're going to find out anyway.'" Though Saun does not suffer from excessive sweating herself, she's learned all about the difficulties of being fashionable if you have to contend with hyperhidrosis. "Most people who suffer from this condition won't wear anything strapless or sleeveless; they wear doubles and triples of tops…. It completely changes your whole wardrobe and affects every part of your life."

Michelle Vicari, a zoologist who has primary focal hyperhidrosis, says the condition caused her to "suffer on a daily basis" until she found relief with treatment. "In my professional life, I always [thought] 'they're not listening to me — they're focusing on my large sweat rings.' I would not go out with friends because I would be very uncomfortable. I'd never go into a [clothing] store without thinking, 'How badly will my sweat show up on this?'" Worse yet, Vicari believed that her excessive sweat was something she simply had to live with. "Since it wasn't something I talked about even with close friends, I never thought to try to do anything about it. I had asked some of my doctors, and the response I got was always something like, 'You just need to learn to relax.'"

As with many other conditions, women are more likely than men to seek treatment for hyperhidrosis, but according to a 2007 ADD survey, not overwhelmingly so. Only two out of five respondents in an IHHS poll said they would even attempt to seek care from a professional if they experienced excessive sweating. Doris J. Day, M.D., a cosmetic dermatologist and assistant clinical professor at New York University, believes that social taboos about sweating and a lack of readily available information on treatment stop many people — especially women — from getting help.

In fact, it took Michelle Vicari more than 10 years until she finally got the kind of relief she needed. A radio commercial advertising a surgical remedy for excessive sweat prompted her to research the condition and learn about possible solutions, which helped her to find a knowledgeable physician.

Treatments for Excessive Sweating

The initial approach to treating hyperhidrosis generally involves antiperspirants (either over-the-counter or prescription strength), which are less invasive and more easily accessible than other options. Antiperspirants generally work best for mild to moderate cases. For patients whose hyperhidrosis is triggered by stress, oral medications for anxiety and depression can also be considered. If a combination of antiperspirant and oral medication fails to yield a reduction in sweat, Botox injections, which were approved for excessive sweating in 2004, can be administered in the underarms at six-month intervals; many physicians also administer injections in the hands, feet, and groin (though FDA approval is limited to the underarms at this time). In cases where all options are exhausted without success, surgery to remove sweat glands or procedures to halt nerve signals that cause the body to perspire can be performed to permanently stop excessive sweating.

Every six months Vicari now receives Botox injections in her underarms, a process that blocks chemicals that stimulate her sweat glands. She reports that the treatment is so effective at managing her excessive sweating that she remains perspiration free even when she does not wear deodorant. Still, the path to finding this relief did not come easily. Vicari admits to feeling alone with the condition for many years, though the reality was quite the opposite. "I had friends with the same problem for years," she says, noting that she only learned of their shared distress once she opened up about her own treatment success. This common scenario may be exaggerated by fears of appearing unladylike or inappropriate.

Even when patients do approach a doctor about the problem, it can come up in a roundabout way. In her practice, Dr. Day has found that many patients mention sweating issues as an afterthought during a dermatological visit, and often she must encourage a more in-depth conversation on the topic. She has learned to ask certain clear-cut questions, such as, "Do you change your clothes several times a day?" or "Do you carry an antiperspirant with you on a regular basis?" to help determine the severity of their problem. After determining a diagnosis, finding an appropriate treatment, she says, is the easy part.

Knowing just how difficult it can be for someone to talk about an excessive sweating problem, clothing designer Kara Saun has become a somewhat unlikely advocate for hyperhidrosis treatment. And she speaks up when a client expresses concerns on the topic. "I say, 'Read all the info that's available to you and see a dermatologist [who can help you find] the best treatment option." The designer, who has observed firsthand just how greatly an effective treatment can boost self-confidence, says she is happy to help get the word out.

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